Antonella Al Refaie

Background: Bone Marrow Edema Syndrome (BMEs) encompasses primary clinical conditions characterized by pain and high-intensity signals on fluid-sensitive magnetic resonance imaging at the subchondral bone level. This study aimed to evaluate bone mineral density (BMD) and turnover markers in BMEs patients compared to a healthy control group. Methods: We selected from the records 165 patients—comprising Complex Regional Pain Syndrome type 1 (CRPS-1, n = 61), hip BMEs (n = 42), and knee BMEs (n = 62)—alongside 150 age- and sex-matched healthy controls. Assessments included bone turnover markers, vitamin D levels, and BMD at the lumbar spine and femur by Dual-Energy X-ray Absorptiometry. Trabecular Bone Score (TBS) was calculated to estimate bone microarchitecture. Results: BMEs patients demonstrated significantly lower BMD across all skeletal sites and reduced TBS values compared to controls. Osteoporosis prevalence was significantly higher in all BMEs subgroups, with CRPS-1 and hip BMES patients showing higher rates than those with knee BMEs. No significant differences were observed in vitamin D or bone turnover markers between groups. Conclusions: Patients with CRPS-1 and BMEs of the hip or knee exhibit a higher prevalence of osteoporosis and compromised bone microarchitecture. These findings highlight a significant association between BME-related conditions and altered BMD/TBS parameters, suggesting a potential shared pathophysiological link.

Background: Dietary calcium and dairy products are hypothesized protective factors against metabolic syndrome (MetS), yet epidemiological evidence remains inconsistent. This systematic review and meta-analysis evaluated the association between total dietary calcium intake or dairy consumption and MetS prevalence in adults. Methods: Following PRISMA 2020 guidelines, PubMed, Cochrane Library, ClinicalTrials.gov, and SCOPUS were searched through to October 2025 for eligible cross-sectional studies assessing dietary calcium or dairy intake and MetS (NCEP ATP III, IDF, or JIS criteria). Longitudinal studies, non-English articles, and pediatric populations were excluded. Quality was assessed via an adapted Newcastle–Ottawa Scale. Random-effects meta-analyses pooled fully adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing the highest versus lowest intake categories. Results: Twenty-four studies were included (12 for dietary calcium intake, 12 for dairy products). Higher dietary calcium intake was significantly associated with lower MetS odds (pooled OR: 0.85; 95% CI: 0.80–0.91), despite substantial heterogeneity (I² = 70.1%). Higher dairy consumption was also inversely associated with MetS (pooled OR: 0.78; 95% CI: 0.72–0.85; I² = 64.6%). While small-study effects were observed for dairy, trim-and-fill analysis confirmed the robustness of the findings. Higher calcium intake further correlated with favorable profiles in individual MetS components, including blood pressure, HDL cholesterol, waist circumference, triglycerides, and fasting glucose. Conclusions: Higher total dietary calcium intake and dairy product consumption are associated with a lower prevalence of MetS in adults. However, the cross-sectional nature of the included studies precludes any inference of causality between calcium intake and MetS. Therefore, although these findings suggest a protective role of calcium-rich diets, well-designed prospective and interventional studies are warranted to clarify whether this relationship is causal.

Background/Objectives: A significantly higher fracture risk characterizes Type 2 diabetes mellitus (T2DM) patients when compared to the non-diabetic population, even though their average bone mineral density (BMD) tends to be normal or high. This elevated risk is primarily driven by defective bone quality. The trabecular bone score (TBS) and radiofrequency echographic multispectrometry (REMS) have recently been proposed to improve the assessment of bone quality in T2DM individuals. This study aimed to evaluate whether TBS and REMS can improve the identification of osteoporosis and fracture risk in these patients. Methods: BMD was measured in 223 consecutive T2DM patients (126 women and 97 man) and 102 controls. BMD values for the lumbar spine (LS), femoral neck (FN), and total hip (TH) were obtained via both dual-energy X-ray absorptiometry (DXA) and radiofrequency echographic multi-spectrometry (REMS). In all patients, TBS and Fragility Score (FS) by REMS were measured and prior major osteoporotic fractures (MOF) were assessed. Results: All BMD T-scores measured by REMS were significantly lower than those obtained by DXA at both lumbar and femoral sites. T2DM patients with previous MOF exhibited lower T-scores for both BMD-LS and BMD-TH, as assessed by DXA and REMS, compared with patients without fractures. However, these differences reached statistical significance for BMD-TH with both techniques and for BMD-LS with REMS, but not for BMD-LS with DXA. Moreover, patients with a history of MOF had significantly lower TBS values (p < 0.05) and significantly higher FS values at both lumbar (p < 0.05) and femoral (p < 0.01) sites compared with those without fractures. Conclusions: The results of this study suggest that the parameters obtained using REMS technology (BMD and FS) may be valuable tools for improving the diagnosis of osteoporosis and assessing fracture risk in patients with T2DM.

Background: Calcium is the most abundant mineral in the human body and is essential not only for bone health but also for many other physiological functions. In fact, dietary calcium intake is important not only for bone health but also for fat mass and overall body composition. This study aimed to evaluate the potential effects of dietary calcium intake on bone mineral density (BMD), body composition, and fragility fractures. Methods: In a cohort of 173 consecutive elderly men and 939 women aged 55 and over, living in Siena, Italy, daily dietary calcium intake was evaluated using a food frequency questionnaire (FFQ) specifically validated for the Italian population. Bone mineral density at various skeletal sites and body composition were measured in all participants using a Lunar Prodigy densitometer. Additionally, the serum levels of vitamin D and bone turnover markers were assessed, and the presence of prevalent atraumatic fractures was documented. Results: Across all age groups, calcium intake was consistently higher in males (898.40 ± 312.87 mg/day) than in females (821.95 ± 351.3 mg/day); the prevalence of subjects in the lowest tertile of calcium intake was significantly higher among females than males (31.4% vs. 14.5% p < 0.05). Moreover, dietary calcium intake showed an inverse relationship with body fat mass in women (p < 0.05) and a positive association with lean mass in men (p < 0.05). Two hundred twenty-eight (24.3%) women and forty-eight (27.8%) men had a history of one or more fractures, and in both sexes, subjects with prevalent fractures had significantly lower dietary calcium intake values than those without fractures. Conclusions: This study indicates that inadequate calcium intake remains widespread in the Italian population, especially among subjects with low BMD and a history of fractures. Furthermore, this study confirms that dietary calcium intake significantly affects body composition.

Nowadays, the interest in the extraskeletal effects of vitamin D is growing. In the literature, its several possible actions have been confirmed. Vitamin D seems to have a regulatory role in many different fields—inflammation, immunity, and the endocrine system—and many studies would demonstrate a possible correlation between vitamin D and cardiovascular disease. In this paper, we deepened the relationship between vitamin D and dyslipidemia by reviewing the available literature. The results are not entirely clear-cut: on the one hand, numerous observational studies suggest a link between higher serum vitamin D levels and a beneficial lipid profile, while on the other hand, interventional studies do not demonstrate a significant effect. Understanding the possible relationship between vitamin D and dyslipidemia may represent a turning point: another link between vitamin D and the cardiovascular system.

This study aimed to estimate the utility of the Radiofrequency Echographic Multispectrometry (REMS) approach in the assessment of bone mineral density (BMD) in subjects with osteogenesis imperfecta (OI). In 41 subjects (40.5 ± 18.7 years) with OI and in 36 healthy controls, we measured BMD at the lumbar spine (LS-BMD), femoral neck (FN-BMD) and total hip (TH-BMD), employing a dual-energy X-ray absorptiometry tool. Additionally, REMS scans were also performed at the lumbar and femoral sites. The presence and number of reported fractures were assessed in the study population. Patients characterized by a history of fragility fractures represented 84.5% of the study population. OI subjects showed significantly reduced BMD values both at the level of the lumbar spine and the femoral subregions (p < 0.01) compared to healthy controls when performed using both the DXA and the REMS method. Dividing OI patients on the basis of the Sillence classification, no differences were found between the LS-BMD values carried out using the DXA technique between the OI type I group and OI Type III and IV groups. On the contrary, the OI Type III and IV groups presented significantly lower values of both Trabecular Bone Score (TBS) and LS-BMD through REMS with respect to OI type I patients (p < 0.05). Based on the data of this study, it is possible to conclude that even the new REMS assessment, which does not use ionizing radiation, represents an excellent method for studying the bone status in subjects affected by OI.

Osteoporosis is a frequently occurring skeletal disease, and osteoporosis-related fractures represent a significant burden for healthcare systems. Dual-Energy X-ray Absorptiometry (DXA) is the most commonly used method for assessing bone mineral density (BMD). Today, particular attention is being directed towards new technologies, especially those that do not use radiation, for the early diagnosis of altered bone status. Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology that evaluates the bone status at axial skeletal sites by analyzing raw ultrasound signals. In this review, we evaluated the data on the REMS technique present in the literature. The literature data confirmed diagnostic concordance between BMD values obtained using DXA and REMS. Furthermore, REMS has adequate precision and repeatability characteristics, is able to predict the risk of fragility fractures, and may be able to overcome some of the limitations of DXA. In conclusion, REMS could become the method of choice for the assessment of bone status in children, in women of childbearing age or who are pregnant, and in several secondary osteoporosis conditions due to its good precision and replicability, its transportability, and the absence of ionizing radiation. Finally, REMS may allow qualitative and not just quantitative assessments of bone status.